A comparison of Selective Aortic Arch Perfusion and Resuscitative Endovascular Balloon Occlusion of the Aorta for the management of hemorrhage-induced traumatic cardiac arrest: A translational model in large swine

Abstract Background The administration of epinephrine in the management of non-traumatic cardiac arrest remains recommended despite controversial effects on neurologic outcome. The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) could be an interesting alternative. The aim of this study was to compare the effects of these 2 strategies on return of spontaneous circulation (ROSC) and cerebral hemodynamics during cardiopulmonary resuscitation (CPR) in a swine model of non-traumatic cardiac arrest. Results Anesthetized pigs were instrumented and submitted to ventricular fibrillation. After 4 min of no-flow and 18 min of basic life support (BLS) using a mechanical CPR device, animals were randomly submitted to either REBOA or epinephrine administration before defibrillation attempts. Six animals were included in each experimental group (Epinephrine or REBOA). Hemodynamic parameters were similar in both groups during BLS, i.e., before randomization. After epinephrine administration or REBOA, mean arterial pressure, coronary and cerebral perfusion pressures similarly increased in both groups. However, carotid blood flow (CBF) and cerebral regional oxygenation saturation were significantly higher with REBOA as compared to epinephrine administration (+ 125% and + 40%, respectively). ROSC was obtained in 5 animals in both groups. After resuscitation, CBF remained lower in the epinephrine group as compared to REBOA, but it did not achieve statistical significance. Conclusions During CPR, REBOA is as efficient as epinephrine to facilitate ROSC. Unlike epinephrine, REBOA transitorily increases cerebral blood flow and could avoid its cerebral detrimental effects during CPR. These experimental findings suggest that the use of REBOA could be beneficial in the treatment of non-traumatic cardiac arrest.

Download Full-text

Resuscitative Endovascular Balloon Occlusion of the Aorta for Refractory Out-of-Hospital Non-Traumatic Cardiac Arrest – A Case Report

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19004795 ◽

2019 ◽

Vol 34 (05) ◽

pp. 566-568 ◽

Cited By ~ 1

Author(s):

Carlo Coniglio ◽

Lorenzo Gamberini ◽

Cristian Lupi ◽

Piergiorgio Cavallo ◽

Marco Tartaglione ◽

...

Keyword(s):

Cardiac Arrest ◽

Case Report ◽

Animal Studies ◽

Life Support ◽

Advanced Cardiac Life Support ◽

Spontaneous Circulation ◽

Balloon Occlusion ◽

Coronary Perfusion ◽

Traumatic Cardiac Arrest ◽

Endovascular Balloon Occlusion

AbstractResuscitative endovascular balloon occlusion of the aorta (REBOA) is a percutaneous transfemoral balloon technique used in select centers for resuscitation and temporary hemostasis of bleeding patients. Several animal studies demonstrated that its application in non-traumatic cardiac arrest could enhance cerebral and coronary perfusion during cardiopulmonary resuscitation (CPR); despite this, there are few reports of its application in humans. This is a case report of REBOA application during a refractory out-of-hospital cardiac arrest in a 50-year-old man where Advanced Cardiac Life Support (ACLS) alone was unable to maintain a stable return of spontaneous circulation (ROSC) and Extracorporeal Cardiac Life Support (ECLS) was not available.

Download Full-text

Use of ER-REBOA to Reverse Traumatic Arrest After Non-Truncal Bleeding

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v2i1.33 ◽

2018 ◽

Vol 2 (1) ◽

Author(s):

M. Chance Spalding ◽

Matthew L Moorman ◽

John B Holcomb

Keyword(s):

Cardiac Arrest ◽

Balloon Occlusion ◽

Successful Case ◽

Endovascular Balloon Occlusion

We report a successful case of resuscitative endovascular balloon occlusion of the aorta (REBOA) to control hemorrhage in a patient with cardiac arrest secondary to non-truncal hemorrhage.

Download Full-text

176 Use of Disposable Pressure Transducer With Resuscitative Endovascular Balloon Occlusion of the Aorta in Medical Cardiac Arrest

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2020.09.188 ◽

2020 ◽

Vol 76 (4) ◽

pp. S68-S69

Author(s):

J. Daley ◽

R. Buckley ◽

K. Cannon

Keyword(s):

Cardiac Arrest ◽

Pressure Transducer ◽

Balloon Occlusion ◽

Endovascular Balloon Occlusion

Download Full-text

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic out-of-hospital cardiac arrest: evaluation of an educational programme

BMJ Open ◽

10.1136/bmjopen-2018-027980 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027980 ◽

Cited By ~ 9

Author(s):

Jostein Rødseth Brede ◽

Thomas Lafrenz ◽

Andreas J Krüger ◽

Edmund Søvik ◽

Torjus Steffensen ◽

...

Keyword(s):

Cardiac Arrest ◽

Critical Incident ◽

Life Support ◽

Objective Assessment ◽

Training Programme ◽

Educational Programme ◽

Balloon Occlusion ◽

Thoracic Level ◽

Hospital Cardiac Arrest ◽

Endovascular Balloon Occlusion

BackgroundOut-of-hospital cardiac arrest (OHCA) is a critical incident with a high mortality rate. Augmentation of the circulation during cardiopulmonary resuscitation (CPR) might be beneficial. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) redistribute cardiac output to the organs proximal to the occlusion. Preclinical data support that patients in non-traumatic cardiac arrest might benefit from REBOA in the thoracic level during CPR. This study describes a training programme to implement the REBOA procedure to a prehospital working team, in preparation to a planned clinical study.MethodsWe developed a team-based REBOA training programme involving the physicians and paramedics working on the National Air Ambulance helicopter base in Trondheim, Norway. The programme consists of a four-step approach to educate, train and implement the REBOA procedure in a simulated prehospital setting. An objective structured assessment of prehospital REBOA application scoring chart and a special designed simulation mannequin was made for this study.ResultsSeven physicians and 3 paramedics participated. The time needed to perform the REBOA procedure was 8.5 (6.3–12.7) min. The corresponding time from arrival at scene to balloon inflation was 12.0 (8.8–15) min. The total objective assessment scores of the candidates’ competency was 41.8 (39–43.5) points out of 48. The advanced cardiovascular life support (ACLS) remained at standard quality, regardless of the simultaneous REBOA procedure.ConclusionThis four-step approach to educate, train and implement the REBOA procedure to a prehospital working team ensures adequate competence in a simulated OHCA setting. The use of a structured training programme and objective assessment of skills is recommended before utilising the procedure in a clinical setting. In a simulated setting, the procedure does not add significant time to the prehospital resuscitation time nor does the procedure interfere with the quality of the ACLS.Trial registration numberNCT03534011.

Download Full-text